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It has become commonplace to say that the decline of rheu matic fever in Europe and North America has little, if any thing, to do with medicine; but to conclude that efforts to control the disease are futile would be an error leading to what could be termed public health malpractice. The need for adequate treatment of patients suffering from acute rheu matic fever or chronic rheumatic valvular heart disease is obvious; but control also means prevention, and here, too, the need is obvious, if only to lighten the burden on health care, due especially to the treatment of patients with advanced...

Today rheumatic fever is still the most common cause of heart disease in children and young adults in developing countries. This disease is typically associated with poverty, in particular with poor housing, overcrowding and inadequate medical care. Rheumatic fever has almost disappeared from economically developed countries; this trend has paralleled improvements in standards of living. However, the recent resurgence of rheumatic fever in middle-class families in the U. S. A. has re-emphasized the importance of this disease in the developed countries as well. Prevention and control of...